SELA Account Activation

Thank you for choosing to activate a Software for Ergonomic Learning and Assessment account.

Please provide the following information about the individual that will be completing the E-Learning modules and the workstation ergonomic self-assessment:

    ACTIVATE A USER ACCOUNT FOR:

    first and last Name: *

    email: *

    COMPANY INFORMATION

    Company Name: *

    Policy Number:

    Company Location (city): *

    Department Name: *

    REQUESTOR INFORMATION

    Name of the individual initiating this request: *

    Email of the individual initiating this request: *

    comments: